Mandatory Reporting Thresholds Friday, October 09, 2015

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Mandatory Reporting Thresholds Friday, October 09, 2015"

Transcription

1 Slide 1 - of 26 Welcome to the Mandatory Reporting Thresholds course. Note: This module applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via an electronic file submission as well as those RREs that will be submitting this information via Direct Data Entry (DDE). Page 1 of 31

2 Slide 2 - of 26 While all information in this document is believed to be correct at the time of writing, this Computer Based Training (CBT) is for educational purposes only and does not constitute official Centers for Medicare & Medicaid Services (CMS) instructions for the MMSEA Section 111 implementation. All affected entities are responsible for following the instructions found at the following link: Page 2 of 31

3 Slide 3 - of 26 This learning module explains the Total Payment Obligation to Claimant (TPOC) dollar threshold reporting requirements which have been established for Section 111 reporting, the TPOC dollar threshold reporting requirements for workers compensation claims with no Ongoing Responsibility for Medicals (ORM) and the TPOC dollar thresholds for certain liability insurance (including selfinsurance) claims with no ORM. It also explains the reporting exclusion for workers compensation claims with ORM. This module concludes with various examples of how to submit claims with these situations. NOTE: Liability insurance (including self-insurance), no-fault insurance, and workers compensation are sometimes collectively referred to as non-group health plan or NGHP. The term NGHP will be used in this CBT for ease of reference. Page 3 of 31

4 Slide 4 - of 26 CMS has defined mandatory reporting thresholds solely for purposes of the required Section 111 Medicare Secondary Payer (MSP) reporting requirements. These thresholds are not exceptions for any other obligation or responsibility of any individual or entity with respect to the MSP provisions. These TPOC dollar thresholds only apply to liability insurance (including self-insurance) and workers compensation (Plan Insurance Type L or E ) add records that do not have ORM (i.e., the ORM Indicator = N ). Page 4 of 31

5 Slide 5 - of 26 RREs are required to report ORM. There is no de minimis dollar threshold for reporting the assumption/establishment of ORM. ORM is to be reported as an add record as soon as it has been established. RREs are required to report no-fault insurance ORM that exists on or after January 1, 2010, regardless of the date of an initial acceptance of payment responsibility. The TPOC mandatory reporting thresholds and exclusion do not apply. RREs are required to report liability insurance (including self-insurance) ORM that exists on or after January 1, 2010, regardless of the date of an initial acceptance of payment responsibility. TPOC mandatory reporting thresholds and exclusion do not apply to liability insurance (including self-insurance) ORM. RREs are required to report workers compensation ORM that exists on or after January 1, 2010, regardless of the date of an initial acceptance of payment responsibility. Page 5 of 31

6 The TPOC mandatory reporting thresholds do not apply to workers compensation ORM. However, certain workers compensation ORM claims are excluded from reporting if they meet the criteria explained on the next slide. Page 6 of 31

7 Slide 6 - of 26 Workers compensation claims that meet all of the following criteria are excluded from reporting until further notice: the claim is for medicals only ; the associated lost time for the worker is no more than the number of days permitted by the applicable workers' compensation law for a medicals only claim (or 7 calendar days if the applicable law has no such limit); all payments have been made directly to the medical provider; and the total payment for medicals does not exceed $750. Please note: Once a workers compensation ORM claim is excluded from reporting, it does not need to be reported unless the circumstances change such that it no longer meets the exclusion criteria listed. In other words, the claim does not need to be reported unless something other than medicals is included, there is more lost time, a payment is made to someone other than a provider, and/or payments for medicals exceed $750. Page 7 of 31

8 Slide 7 - of 26 A Medicare beneficiary is injured on the job on 2/15/2009, is out of work for 8 days, and files a workers' compensation claim. The workers' compensation insurer assumes responsibility for his associated medicals (medical costs). The claim remains open and the workers' compensation insurer continues to have responsibility for medicals on or after 1/1/2010. There is no settlement, judgment, award, or other payment aside from the assumption of responsibility for medicals. To date, the total payment for medicals is $6,300. In this example, this claim does not meet all of the criteria for the workers compensation exclusion, and therefore should be reported. To review: ORM exists as of 1/1/2010, the workers compensation ORM reporting threshold was exceeded because medicals were greater than $750, and the beneficiary was out of work for more than the associated time allowable for a medicals only claim. As a result, the claim should be reported. Page 8 of 31

9 Slide 8 - of 26 For this example, a Medicare beneficiary is injured on the job on 8/20/2009, is out of work for 3 days, and files a workers' compensation claim. The workers' compensation insurer assumes responsibility for the associated medicals (medical costs). This is a medicals only claim. The claim remains open and the workers' compensation insurer continues to have the responsibility for medicals on or after 1/1/2010. There is no settlement, judgment, award, or other payment aside from the assumption of responsibility for medicals. The total payment to date, $600, was made directly to the provider. In this example, the claim meets all of the criteria for the workers compensation exclusion and should not be reported. Although ORM exists as of 1/1/2010, all of the criteria of the workers compensation exclusion were met (i.e., this is a medicals only claim, the associated lost time was not more than the number of days permitted by the applicable workers compensation law for medicals only, Page 9 of 31

10 the payment was made directly to the provider and the total payment did not exceed $750); therefore, this claim is excluded from reporting. Page 10 of 31

11 Slide 9 - of 26 RREs are required to report all no-fault insurance TPOCs with dates of October 1, 2010 and subsequent. The thresholds are not applicable to no-fault. RREs may, but are not required to include no-fault TPOCs with dates prior to October 1, For liability insurance (including self-insurance) TPOCs, RREs are required to report TPOC Dates of October 1, 2011 and subsequent. RREs may, but are not required to include TPOCs with dates prior to October 1, RREs are required to report liability insurance (including self-insurance) TPOCs only if the cumulative TPOC Amount exceeds the reporting threshold for the most recent TPOC Date. The Benefits Coordination & Recovery Center (BCRC) will total all TPOC Amounts reported on the claim record when determining if the claim meets the applicable reporting threshold. The reporting thresholds are applicable to liability insurance (including self-insurance) TPOCs. For workers compensation, RREs are required to report TPOCs with dates of October 1, 2010 and subsequent. RREs may, but are not required to include TPOCs with dates prior to October 1, Page 11 of 31

12 RREs are required to report workers compensation TPOCs only if the cumulative TPOC Amount exceeds the reporting threshold for the most recent TPOC Date. The BCRC will total all TPOC Amounts reported on the claim record when determining if the claim meets the applicable reporting threshold. Page 12 of 31

13 Slide 10 - of 26 CMS has revised the implementation timeline and TPOC dollar thresholds for certain liability insurance, including self-insurance, (plan insurance type L ) TPOC settlements, judgments, awards, or other payments. If the most recent TPOC Date is on or between October 1, 2011 and March 31, 2012, and the cumulative TPOC Amount is greater than $100,000, the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning January 1, For this date range, TPOCs greater than $5,000 through $100,000 may be reported, but there is no requirement to do so. If an add record is submitted for this date range with a total TPOC Amount less than or equal to $5,000, the claim report will reject with a CJ07 error. If the most recent TPOC Date is on or between April 1, 2012 and June 30, 2012, and the cumulative TPOC Amount is greater than $50,000, the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning July 1, Page 13 of 31

14 For this date range, TPOCs greater than $5,000 through $50,000 may be reported, but there is no requirement to do so. If an add record is submitted for this date range with a total TPOC Amount less than or equal to $5,000, the claim report will reject with a CJ07 error. If the most recent TPOC Date is on or between July 1, 2012 and September 30, 2012, and the cumulative TPOC Amount is greater than $25,000, the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning October 1, For this date range, TPOCs greater than $5,000 through $25,000 may be reported, but there is no requirement to do so. If an add record is submitted for this date range with a total TPOC Amount less than or equal to $5,000, the claim report will reject with a CJ07 error. If the most recent TPOC Date is on or between October 1, 2012 and September 30, 2013, and the cumulative TPOC Amount is greater than $5,000, the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning January 1, For this date range, TPOCs greater than $300 through $5,000 may be reported, but there is no requirement to do so. If an add record is submitted for this date range with a total TPOC Amount less than or equal to $300, the claim report will reject with a CJ07 error. If the most recent TPOC Date is on or between October 1, 2013 and September 30, 2014, and the cumulative TPOC Amount is greater than $2,000, the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning January 1, For this date range, TPOCs greater than $300 through $2,000 may be reported, but there is no requirement to do so. If an add record is submitted for this date range with a total TPOC Amount less than or equal to $300, the claim report will reject with a CJ07 error. If the most recent TPOC Date is on or after October 1, 2014, and the cumulative TPOC Amount is greater than $1,000, the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning January 1, For this date range, TPOCs greater than $300 through $1,000 may be reported, but there is no requirement to do so. If an add record is submitted for this date range with a total TPOC Amount less than or equal to $300, the claim report will reject with a CJ07 error. Note: RREs may submit TPOCs that are less than or equal to the TPOC dollar threshold on an add record only if the claim has ORM. Page 14 of 31

15 Slide 11 - of 26 CMS has revised the timeline and TPOC dollar thresholds for workers compensation (plan insurance type E ) TPOC settlements, judgments, awards, or other payments. If the most recent TPOC Date is on or between October 1, 2010 and September 30, 2013, and the cumulative TPOC Amount is greater than $5,000, the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning January 1, Beginning January 1, 2013, TPOCs greater than $300 through $5,000 may be reported, but there is no requirement to do so. Beginning January 1, 2013, if an add record is submitted for this date range with a total TPOC Amount less than or equal to $300, the claim report will reject with a CJ07 error. If the most recent TPOC Date is on or between October 1, 2013 and September 30, 2014, and the cumulative TPOC Amount is greater than $2,000, Page 15 of 31

16 the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning January 1, For this date range, TPOCs greater than $300 through $2,000 may be reported, but there is no requirement to do so. If an add record is submitted for this date range with a total TPOC Amount less than or equal to $300, the claim report will reject with a CJ07 error. If the most recent TPOC Date is on or after October 1, 2014, and the cumulative TPOC Amount is greater than $300, the TPOC(s) must be reported no later than the end of the RRE s submission timeframe in the quarter beginning January 1, If an add record is submitted for this date range with a total TPOC Amount less than or equal to $300, the claim report will reject with a CJ07 error. Note: RREs may submit TPOCs that are less than or equal to the TPOC dollar threshold on an add record only if the claim has ORM. The TPOC reporting thresholds do not apply to these records. If submitted, the claim report will not reject with the CJ07 error. However, RREs must submit TPOCs for these claim reports if the established cumulative TPOC Amount exceeds the TPOC dollar thresholds. Page 16 of 31

17 Slide 12 - of 26 The CJ07 error code is triggered if you submit a claim report (that is, add a record with no ORM) that has a total TPOC amount that is less than the minimum allowed for the most recent TPOC Date (if more than one TPOC is submitted on a claim report). Note: TPOC liability reporting has been updated to reflect a lower limit threshold change from $300 to $1,000. Liability Insurance (including self-insurance) claim reports with no ORM and cumulative TPOC amounts less than or equal to $1,000 will reject with a CJ07 error, if the most recent TPOC date is October 1, 2014 or after. Page 17 of 31

18 Slide 13 - of 26 The CJ07 error code is triggered if you submit a claim report (that is, add a record with no ORM) that has a total TPOC amount that is less than the minimum allowed for the most recent TPOC Date (if more than one TPOC is submitted on a claim report). Note: TPOC liability reporting has been updated to reflect a lower limit threshold change from $300 to $1,000. Liability Insurance (including self-insurance) claim reports with no ORM and cumulative TPOC amounts less than or equal to $1,000 will reject with a CJ07 error, if the most recent TPOC date is October 1, 2014 or after. Where there are multiple TPOCs reported by the same RRE on the same record, the combined TPOC Amounts must be considered in determining whether or not the reporting threshold is met. For TPOCs involving a deductible, where the RRE is responsible for reporting both any deductible and any amount above the deductible, the threshold applies to the total of these two figures. Page 18 of 31

19 Slide 14 - of 26 To determine which threshold date range the TPOC falls into, the RRE will compare the most recent (or only) TPOC Date to the threshold date ranges. If the cumulative TPOC Amount associated with the claim is greater than the threshold amount for the threshold date range, the claim record must be reported. Page 19 of 31

20 Slide 15 - of 26 Suppose an RRE has a workers' compensation claim TPOC with a date of 10/1/2011. The associated TPOC Amount is $1,000. This TPOC is not yet reportable. The TPOC Date falls between the TPOC Date range of 10/1/2010 to 9/30/2013. For this date range, the cumulative TPOC Amount must be more than $5,000 to be reportable. Therefore, this TPOC is not yet reportable. On 11/30/2011, the RRE has another TPOC for the same workers compensation claim with an associated TPOC Amount of $4,500. The cumulative TPOC Amount total is $5,500. The most recent TPOC Date is 11/30/2011. This date falls into the threshold date range of 10/1/2010 to 9/30/2013. For this date range the cumulative TPOC Amount must be more than $5,000. Therefore, the workers compensation claim must now be reported and both TPOCs must be included, one in the TPOC Date and Amount 1 fields and the other on the Claim Input File Auxiliary Record in the TPOC Date and Amount 2 fields. Page 20 of 31

21 Slide 16 - of 26 Suppose an RRE has a liability insurance (including self-insurance) claim TPOC with a date of 1/1/2013. The associated TPOC Amount is $1,000. This TPOC is not yet reportable. The TPOC Date falls into the TPOC Date range of 10/1/2012 to 9/30/2013. For this date range, the cumulative TPOC Amount must be more than $5,000 to be reportable. Therefore, this TPOC is not yet reportable. On 6/30/2013, the RRE has another TPOC for the same liability insurance (including self-insurance) claim with an associated TPOC Amount of $4,500. The cumulative TPOC Amount total is $5,500. The most recent TPOC Date is 6/30/2013. This date falls into the threshold date range 10/1/2012 9/30/2013. For this date range the cumulative TPOC Amount must be more than $5,000. Therefore, the liability insurance (including self-insurance) claim must now be reported and both TPOCs must be included, one in the TPOC Date and Amount 1 fields and the other on the Claim Input File Auxiliary Record in the TPOC Date and Amount 2 fields. Page 21 of 31

22 Slide 17 - of 26 Let s assume an RRE has a liability insurance (including self-insurance) claim with a TPOC Date of 4/1/2012. The associated TPOC Amount is $25,000. Since the TPOC Amount is less than the required reporting threshold for this timeframe, the RRE does not have to report it. However, since it exceeds the reporting threshold of $5,000 for this timeframe, the RRE may report it if they choose to do so. Page 22 of 31

23 Slide 18 - of 26 Now, let s assume an RRE has a liability insurance (including self-insurance) claim with a TPOC Date of 4/1/2012. The associated TPOC Amount is $55,000. Since the TPOC Amount exceeds the required reporting threshold ($50,000) for this timeframe, the RRE must report this TPOC in the third calendar quarter beginning 7/1/2012. Page 23 of 31

24 Slide 19 - of 26 Suppose now that the TPOC Date is 4/1/2012 and the TPOC Amount is $1,000. Since this TPOC is below the reporting threshold of $5,000 for this timeframe, the RRE may NOT report it. An add record submitted with no ORM for an amount under the TPOC threshold will be rejected with the error code CJ07. Page 24 of 31

25 Slide 20 - of 26 The premise for these examples involves a Medicare beneficiary who is injured by a crate falling off a shelf in a retail store. The owner of the store is covered by a general liability insurance policy. A settlement, judgment, award, or other payment is made to the Medicare beneficiary and the insurer has no ORM for the beneficiary. The beneficiary files a claim with the insurer of the liability policy and a settlement is signed by both parties. There is no court involvement. Page 25 of 31

26 Slide 21 - of 26 For our first scenario, a settlement for $4,500 is signed by both parties on 10/3/2011; there is no court involvement. Do not report this claim for Section 111. Although the liability insurance (including self-insurance) TPOC Date is after 10/1/2011, the total TPOC Amount must exceed the required reporting threshold ($100,000) for this timeframe to be reported. Note: Please see the definition of the TPOC Date and TPOC Amount fields in the NGHP User Guide for more information. Page 26 of 31

27 Slide 22 - of 26 For our second scenario, a settlement for $10,000 is signed by both parties on 9/30/2011. Again, there is no court involvement. Since the liability insurance (including self-insurance) TPOC Date is prior to 10/1/2011, this claim report does not have to be reported regardless of the total TPOC Amount, but the RRE may report this at their discretion. Page 27 of 31

28 Slide 23 - of 26 For our third scenario, a settlement for $10,000 is signed by both parties on 10/30/2011. Again, there is no court involvement. Since the liability insurance (including self-insurance) TPOC Date is after 10/1/2011, and the TPOC Amount is over the minimum threshold amount for the applicable date range (i.e., the TPOC Amount is between $5,000 and $100,000), this claim report may be reported. However, due to the reporting thresholds for liability insurance discussed previously, the RRE is not required to report this claim. For liability insurance (including self-insurance) claims with TPOC Dates of 10/1/2011 through 3/31/2012, RREs are only required to report if the total TPOC Amount is greater than $100,000. Page 28 of 31

29 Slide 24 - of 26 For our final scenario, a settlement for $125,000 is signed by both parties on 11/30/2011. Again, there is no court involvement. Since the liability insurance TPOC Date is between 10/1/2011 and 3/31/2012, and the total TPOC Amount exceeds the required reporting threshold ($100,000) for this timeframe, this claim must be reported. Page 29 of 31

30 Slide 25 - of 26 You have completed the Mandatory Reporting Thresholds course. Information in this course can be referenced by using the NGHP User Guide s table of contents. This document is available for download at the following link: Page 30 of 31

31 Slide 26 - of 26 If you have any questions or feedback on this material, please go the following URL: Page 31 of 31

Welcome to the Total Payment Obligation to Claimant (TPOC) course.

Welcome to the Total Payment Obligation to Claimant (TPOC) course. Welcome to the Total Payment Obligation to Claimant (TPOC) course. Note: This module applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via an electronic

More information

Welcome to the Reportable Claims course.

Welcome to the Reportable Claims course. Welcome to the Reportable Claims course. Note: This module applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via an electronic file submission as well

More information

Data Transmission Method Selection Monday, October 5, 2015

Data Transmission Method Selection Monday, October 5, 2015 Slide 1 - of 17 Welcome to the Data Transmission Method Selection course. Note: This module only applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via

More information

Quick Reference Guide Version 1 January 19, 2012

Quick Reference Guide Version 1 January 19, 2012 Centers for Medicare & Medicaid Services (CMS) MMSEA Section 111 Mandatory Insurer Reporting Quick Reference Guide Version 1 January 19, 2012 For Non-Group Health Plan (NGHP) Insurers The What, Why and

More information

Welcome to the International Classification of Diseases, Ninth Revision (ICD-9) Diagnosis Code Requirements Part I course.

Welcome to the International Classification of Diseases, Ninth Revision (ICD-9) Diagnosis Code Requirements Part I course. Welcome to the International Classification of Diseases, Ninth Revision (ICD-9) Diagnosis Code Requirements Part I course. Note: This module applies to Responsible Reporting Entities (RREs) that will be

More information

Welcome to the Medicare Secondary Payer (MSP) Overview course.

Welcome to the Medicare Secondary Payer (MSP) Overview course. Welcome to the Medicare Secondary Payer (MSP) Overview course. 1 While all information in this document is believed to be correct at the time of writing, this Computer Based Training (CBT) is for educational

More information

Welcome to the Health Reimbursement Arrangement (HRA) course.

Welcome to the Health Reimbursement Arrangement (HRA) course. Welcome to the Health Reimbursement Arrangement (HRA) course. 1 While all information in this document is believed to be correct at the time of writing, this Computer Based Training (CBT) is for educational

More information

Welcome to the International Classification of Diseases, ninth revision (ICD-9) Requirements Frequently Asked Questions (FAQ) course.

Welcome to the International Classification of Diseases, ninth revision (ICD-9) Requirements Frequently Asked Questions (FAQ) course. Welcome to the International Classification of Diseases, ninth revision (ICD-9) Requirements Frequently Asked Questions (FAQ) course. 1 Disclaimer While all information in this document is believed to

More information

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter IV: TECHNICAL INFORMATION

More information

Slide notes Welcome to the Section 111 Coordination of Benefits (COB) Secure Website Monitor File Processing course.

Slide notes Welcome to the Section 111 Coordination of Benefits (COB) Secure Website Monitor File Processing course. Slide 1 - of 20 Welcome to the Section 111 Coordination of Benefits (COB) Secure Website Monitor File Processing course. Page 1 of 21 Slide 2 - of 20 While all information in this document is believed

More information

CLM 2016 Atlanta Conference May 19-20, 2016 in Atlanta, GA

CLM 2016 Atlanta Conference May 19-20, 2016 in Atlanta, GA CLM 2016 Atlanta Conference May 19-20, 2016 in Atlanta, GA Medicare Secondary Payer Compliance: The Critical Transition to the Commercial Repayment Center (CRC) What is Medicare? Medicare is an entitlement

More information

Report to Congress. Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold

Report to Congress. Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold Report to Congress Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold As Required by Section 202 of the Medicare IVIG Access and Strengthening Medicare and

More information

made by private organizations (called primary payers or primary plans). 4 This includes liability

made by private organizations (called primary payers or primary plans). 4 This includes liability passage of the Medicare Secondary Payer Act ( MSP ) 2 in 1980 provided for a redistribution of the primary payment burden. 3 Today, Medicare is a secondary payer to other available payment sources for

More information

MEDICARE REPORTING AND RECOVERY UPDATE

MEDICARE REPORTING AND RECOVERY UPDATE CLIENT UPDATE JULY 2012 MEDICARE REPORTING AND RECOVERY UPDATE MMSEA SECTION 111 REPORTING RRES NOT LIMITED TO QUARTERLY REPORTING Responsible Reporting Entities (RREs) were previously required to submit

More information

Submitting Settlement Information Monday, July 13, 2015. Slide 1 - of 21

Submitting Settlement Information Monday, July 13, 2015. Slide 1 - of 21 Slide 1 - of 21 Welcome to the Medicare Secondary Payer Recovery Portal (MSPRP) Submitting Settlement Information course. As a reminder, you may view the slide number you are on by clicking on the moving

More information

Understanding the Medicare, Medicaid and SCHIP Extension Act of 2007

Understanding the Medicare, Medicaid and SCHIP Extension Act of 2007 Understanding the Medicare, Medicaid and SCHIP Extension Act of 2007 CNA believes we are more than your underwriting and risk management provider. Our ongoing customer service, technical support, and consultative

More information

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter III: POLICY GUIDANCE Rev.

More information

SFTP File Transmission for Section 111 Monday, October 5, 2015

SFTP File Transmission for Section 111 Monday, October 5, 2015 Slide 1 - of 23 Welcome to the Secure File Transfer Protocol (SFTP) File Transmission for Section 111 course. Note: This module only applies to Responsible Reporting Entities (RREs) that will be submitting

More information

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE

Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter I: INTRODUCTION AND OVERVIEW

More information

MMSEA Section 111 MSP Mandatory Reporting

MMSEA Section 111 MSP Mandatory Reporting MMSEA Section 111 MSP Mandatory Reporting Interim Record Layout Information for: Liability Insurance (Including Self-Insurance) No-Fault Insurance Workers Compensation The complete Section 111 User Guide

More information

What Every Self-Insured Hospital and Liability Insurance Company Needs to Know before January 2012!

What Every Self-Insured Hospital and Liability Insurance Company Needs to Know before January 2012! Page1 What Every Self-Insured Hospital and Liability Insurance Company Needs to Know before January 2012! Medicare Medicaid SCHIP Extension Act (MMSEA) Section 111 Reporting Requirements This White Paper

More information

Fixed Percentage Option

Fixed Percentage Option Fixed Percentage Option What Is the Fixed Percentage Option? In an effort to streamline the recovery process, the Centers for Medicare & Medicaid Services (CMS), directed the Benefits Coordination & Recovery

More information

Solutions to New Medicare Compliance Rules: A Presentation to the National Council of Self-Insurers. National Coverage

Solutions to New Medicare Compliance Rules: A Presentation to the National Council of Self-Insurers. National Coverage Solutions to New Medicare Compliance Rules: A Presentation to the National Council of Self-Insurers National Coverage Medicare Crisis Medicare is now paying out more than it takes in. Healthcare costs

More information

Welcome to the Medicare Secondary Payer (MSP) Employer Size Guidelines for Group Health Plan (GHP) Arrangements Part 1.

Welcome to the Medicare Secondary Payer (MSP) Employer Size Guidelines for Group Health Plan (GHP) Arrangements Part 1. Slide 1 - of 30 Welcome to the Medicare Secondary Payer (MSP) Employer Size Guidelines for Group Health Plan (GHP) Arrangements Part 1. Page 1 of 30 Slide 2 - of 30 While all information in this document

More information

Best Practices for Complying with New Medicare Reporting Requirements What Every Attorney Needs to Know By Ervin A. Gonzalez, Esq.

Best Practices for Complying with New Medicare Reporting Requirements What Every Attorney Needs to Know By Ervin A. Gonzalez, Esq. Best Practices for Complying with New Medicare Reporting Requirements What Every Attorney Needs to Know By Ervin A. Gonzalez, Esq. I. Overview: How does the MMSEA impact personal injury and mass tort settlements?

More information

CMS Registration and Account Setup

CMS Registration and Account Setup CMS Registration and Account Setup Overview The registration process requires RRE s to provide notification to the COBC of their intent to report data to comply with the requirements of Section 111 of

More information

APPLICABLE PLAN APPEALS

APPLICABLE PLAN APPEALS APPLICABLE PLAN APPEALS Appealing a Medicare Secondary Payer Recovery Claim where Medicare pursues recovery from insurers or workers compensation entities. Presented by: The Division of Medicare Secondary

More information

Workers Compensation Update Special Edition: Medicare Secondary Payer

Workers Compensation Update Special Edition: Medicare Secondary Payer By Roy Franco, Mark Noonan, and Stephanie Sorensen Medicare Secondary Payer Update The Medicare Secondary Payer Act (MSPA) 1 is a game-changer for claims offices across the country. The additional reporting

More information

In 2007, Congress passed Section 111 to the Medicare, Medicaid

In 2007, Congress passed Section 111 to the Medicare, Medicaid SCHOLARLY ARTICLE What Every Attorney Must Know About Medicare Reporting and Reimbursement By Toni J. Ellington In 2007, Congress passed Section 111 to the Medicare, Medicaid and SCHIP Extension Act (MMSEA).

More information

SUBROGATION AND MSAs. Settlement of W/C Claim As Part of Third Party Settlement Commutation/Dollar Contracts, Etc.

SUBROGATION AND MSAs. Settlement of W/C Claim As Part of Third Party Settlement Commutation/Dollar Contracts, Etc. MEDICARE SET-ASIDES AND THE SUBROGATION PROFESSIONAL Presented By: Gary L. Wickert, Matthiesen, Wickert & Lehrer, S.C. Russell S. Whittle, Gould & Lamb, LLC GOTOWEBINAR ATTENDEE INTERFACE 1. Viewer Window

More information

Errors and Omissions Liability Insurance for Medicare Statutory Compliance

Errors and Omissions Liability Insurance for Medicare Statutory Compliance The Problem and the Solution Medicare/Medicaid and SCHIP Extension Act of 2007 Errors and Omissions Liability Insurance for Medicare Statutory Compliance INSURANCE GROUP In 1980, in an effort to help curb

More information

New M&A insurance risk for buyers Medicare-related settlement clawback

New M&A insurance risk for buyers Medicare-related settlement clawback January 2011 A publication from the Transaction Services practice New M&A insurance risk for buyers Medicare-related settlement clawback At a glance Companies across a wide range of industries must consider

More information

MEDICARE AND LIABILITY CASES. A. The Medicare Secondary Payer Statute

MEDICARE AND LIABILITY CASES. A. The Medicare Secondary Payer Statute MEDICARE AND LIABILITY CASES I. The Significant Statutory and Code Provisions A. The Medicare Secondary Payer Statute The Medicare Secondary Payer statute (MSP) has been the law for well over 25 years.

More information

MANDATORY INSURER REPORTING: A PRIMER FOR RESPONSIBLE REPORTING ENTITIES

MANDATORY INSURER REPORTING: A PRIMER FOR RESPONSIBLE REPORTING ENTITIES MANDATORY INSURER REPORTING: A PRIMER FOR RESPONSIBLE REPORTING ENTITIES INTRODUCTION Liability insurers, self-insured entities, and third party administrators should be aware of how Medicare s right to

More information

File Transmission Methods Monday, July 14, 2014

File Transmission Methods Monday, July 14, 2014 Slide 1 - of 27 Version 4.4, 7/14/14 CMS reserves the right to modify this presentation. To ensure you have the most current version, verify that the version and date on this page match the version and

More information

WHAT YOU NEED TO KNOW ABOUT MEDICARE LIENS, CONDITIONAL PAYMENTS, AND SET ASIDE TRUSTS

WHAT YOU NEED TO KNOW ABOUT MEDICARE LIENS, CONDITIONAL PAYMENTS, AND SET ASIDE TRUSTS WHAT YOU NEED TO KNOW ABOUT MEDICARE LIENS, CONDITIONAL PAYMENTS, AND SET ASIDE TRUSTS Presented and Prepared by: Bradford J. Peterson bpeterson@heylroyster.com Urbana, Illinois 217.344.0060 The cases

More information

News & 440 Report. The Florida Bar Workers Compensation Section. www.flworkerscomp.org

News & 440 Report. The Florida Bar Workers Compensation Section. www.flworkerscomp.org The Florida Bar Workers Compensation Section www.flworkerscomp.org News & 440 Report How to Seek Review of Patently Unreasonable Fees after Kauffman Petitions for Rule Nisi Under Section 440.24 Hidden

More information

Medicare, Medicaid, and SCHIP Extension Act: What All Lawyers and Their Clients Must Know About the Act Before Settling a Personal Injury Claim

Medicare, Medicaid, and SCHIP Extension Act: What All Lawyers and Their Clients Must Know About the Act Before Settling a Personal Injury Claim Medicare, Medicaid, and SCHIP Extension Act: What All Lawyers and Their Clients Must Know About the Act Before Settling a Personal Injury Claim SPEAKERS: W. Randall Bassett Stephanie Ann Webster Tara Kay

More information

www.cms.hhs.gov/mandatoryinsrep/01_overview.asp INTRODUCTION October 1, 2010.

www.cms.hhs.gov/mandatoryinsrep/01_overview.asp INTRODUCTION October 1, 2010. 1. INTRODUCTION Recent changes in federal law represent a sea change in the consideration that must be given by defendants to the interests of Medicare. Up until March, 2009, Medicare, when attempting

More information

The Reporting Requirement You May Not Know About that Could Cost Your

The Reporting Requirement You May Not Know About that Could Cost Your The Reporting Requirement You May Not Know About that Could Cost Your Company $1,000 per Day The Mechanics and Litigation Repercussions of MMSEA 111 Jennifer A. Creedon jcreedon@verrilldana.com (617) 309-2618

More information

TRANSITIONING FROM ICD-9 TO ICD-10 CODES PRESENTED OCTOBER 8, 2015 NATALIE RIVERA, RN, MS, BSN, CCM, CNLCP

TRANSITIONING FROM ICD-9 TO ICD-10 CODES PRESENTED OCTOBER 8, 2015 NATALIE RIVERA, RN, MS, BSN, CCM, CNLCP TRANSITIONING FROM ICD-9 TO ICD-10 CODES PRESENTED OCTOBER 8, 2015 NATALIE RIVERA, RN, MS, BSN, CCM, CNLCP ICD-10: INTERNATIONAL CLASSIFICATION OF DISEASES 10 TH REVISION International Classification of

More information

Medicare Secondary Payer (MSP) Liability Insurance, No-Fault Insurance & Workers Compensation Recovery Process

Medicare Secondary Payer (MSP) Liability Insurance, No-Fault Insurance & Workers Compensation Recovery Process Medicare Secondary Payer (MSP) Liability Insurance, No-Fault Insurance & Workers Compensation Recovery Process Note: This presentation is intended for Medicare beneficiaries and their representatives.

More information

MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting

MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter V: APPENDICES Version 4.7

More information

Medicare Indemnity and Defense by Federal Mandate?

Medicare Indemnity and Defense by Federal Mandate? Medicare Indemnity and Defense by Federal Mandate? Christian R. Johnson Ebanks Horne Rota Moos LLP 1301 McKinney, Suite 2700 Houston, TX 77010 (713) 333-4500 (713) 333-4600 [fax] cjohnson@ethlaw.com www.ethlaw.com

More information

MMSEA SECTION 111 MEDICARE SECONDARY PAYER MANDATORY REPORTING

MMSEA SECTION 111 MEDICARE SECONDARY PAYER MANDATORY REPORTING OVERVIEW 1150 Huntington Bldg. 925 Euclid Avenue Cleveland, Ohio 44115-1414 phone 216.592.5000 fax 216.592.5009 Web: www.tuckerellis.com CLEVELAND COLUMBUS DENVER LOS ANGELES SAN FRANCISCO MMSEA SECTION

More information

1, 2011, and will apply to payment obligations assumed on or after October 1, 2010. See

1, 2011, and will apply to payment obligations assumed on or after October 1, 2010. See Medicare Reporting and Reimbursement Compliance Issues in Mass Products Liability Cases in which Exposure on or after December 5, 1980, is Generally Alleged, Established, and/or Released. By: Lynn O. Frye,

More information

Medicare Issues in Workers Compensation Settlements PRESENTED BY: MICHELLE A. ALLAN, ESQ.

Medicare Issues in Workers Compensation Settlements PRESENTED BY: MICHELLE A. ALLAN, ESQ. Medicare Issues in Workers Compensation Settlements PRESENTED BY: MICHELLE A. ALLAN, ESQ. Medicare Basics Medicare is a health insurance program provided by the federal government for: People 65 years

More information

LIEN ON ME. A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44. April, 2009

LIEN ON ME. A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44. April, 2009 LIEN ON ME A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44 April, 2009 HARRISBURG OFFICE P.O. Box 932 Harrisburg, PA 17106-0932 717-975-8114 PITTSBURGH OFFICE 525 William

More information

HOOPS 2008. MSP Update: New Programs, Added Burdens, Possible Expanded Opportunities Focus on CMS Implementation of Mandatory Insurance Reporting

HOOPS 2008. MSP Update: New Programs, Added Burdens, Possible Expanded Opportunities Focus on CMS Implementation of Mandatory Insurance Reporting HOOPS 2008 MSP Update: New Programs, Added Burdens, Possible Expanded Opportunities Focus on CMS Implementation of Mandatory Insurance Reporting Robert L. Roth Crowell & Moring, LLP 1001 Pennsylvania Avenue,

More information

The Medicare Tsunami. Bigger than Medicare Set Asides. Stronger than the Medicare Secondary Payer Act. Faster than the end of the recession

The Medicare Tsunami. Bigger than Medicare Set Asides. Stronger than the Medicare Secondary Payer Act. Faster than the end of the recession The Medicare Tsunami Bigger than Medicare Set Asides Stronger than the Medicare Secondary Payer Act Faster than the end of the recession A Tsunami you can plan for 1 2 Outline Medicare Eligibility MSA

More information

New Medicare Reporting Requirements for Entities Paying Settlements or Judgments To Personal Injury Plaintiffs Who Are Medicare Beneficiaries

New Medicare Reporting Requirements for Entities Paying Settlements or Judgments To Personal Injury Plaintiffs Who Are Medicare Beneficiaries New Medicare Reporting Requirements for Entities Paying Settlements or Judgments To Personal Injury Plaintiffs Who Are Medicare Beneficiaries By Pamela W. Montgomery, R.N., J.D., LL.M. candidate (Health

More information

Medicare in Personal Injury Claims: Understanding the Fundamentals

Medicare in Personal Injury Claims: Understanding the Fundamentals Presenting a live 90-minute webinar with interactive Q&A Medicare in Personal Injury Claims: Understanding the Fundamentals Complying with Reporting Requirements and Satisfying Medicare Liens When Settling

More information

Multi-Factor Authentication (MFA) Monday, December 14, 2015. Slide 1 - of 34

Multi-Factor Authentication (MFA) Monday, December 14, 2015. Slide 1 - of 34 Slide 1 - of 34 Welcome to the Multi-Factor Authentication Process (MFA) course. Note: This course is intended for non-beneficiary MSPRP users to learn how to access previously masked case information.

More information

Workers Compensation & Medicare Set-Asides"

Workers Compensation & Medicare Set-Asides Workers Compensation & Medicare Set-Asides" Presented by: Betty Gregware, CSSC Mutual of Omaha & Toni Warbington, CSSC EPS Settlements Group W/C vs. Tortfeasor Liability" No provision to bring suit against

More information

SPECIAL NEEDS TRUST NEWSLETTER

SPECIAL NEEDS TRUST NEWSLETTER SPECIAL NEEDS TRUST NEWSLETTER SEPTEMBER 2009 A. KEL LONG, III P.C. 3060 Peachtree Rd., Suite 1725 Atlanta, GA 30305 404 238 0174 AKL3PC@mindspring.com www.akellong.com For this edition of the newsletter,

More information

Subrogation and Liens: Basic Principles and Practical Considerations. Brandon E. Berg Thompson, Coe, Cousins & Irons, L.L.P.

Subrogation and Liens: Basic Principles and Practical Considerations. Brandon E. Berg Thompson, Coe, Cousins & Irons, L.L.P. Subrogation and Liens: Basic Principles and Practical Considerations Brandon E. Berg Thompson, Coe, Cousins & Irons, L.L.P. Houston, Texas Texas Hospital Lien Statute Texas Property Code gives a hospital

More information

MEDICARE S SECTION 111 MANDATORY REPORTING PROGRAM

MEDICARE S SECTION 111 MANDATORY REPORTING PROGRAM 1150 Huntington Bldg. 925 Euclid Avenue Cleveland, Ohio 44115-1414 phone 216.592.5000 fax 216.592.5009 Web: www.tuckerellis.com CLEVELAND COLUMBUS DENVER LOS ANGELES SAN FRANCISCO MEDICARE S SECTION 111

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare is denying an increasing number of claims, because providers are not identifying the correct primary payer prior

More information

CENTERS FOR MEDICARE & MEDICAID SERVICES. Moderator: John Albert December 10, 2014 1:00 p.m. ET

CENTERS FOR MEDICARE & MEDICAID SERVICES. Moderator: John Albert December 10, 2014 1:00 p.m. ET Page 1 CENTERS FOR MEDICARE & MEDICAID SERVICES December 10, 2014 1:00 p.m. ET Operator: Good afternoon. My name is (Peter), and I will be your conference operator today. At this time, I would like to

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services News Flash Medicare is denying an increasing number of claims, because providers are not identifying, nor sending claims

More information

Best Practices for Medicare Secondary Payer Compliance Industry Perspectives

Best Practices for Medicare Secondary Payer Compliance Industry Perspectives Best Practices for Medicare Secondary Payer Compliance Industry Perspectives Presenters: Tara Acton, CenturyLink Cliff Connor, Gallagher Bassett Services, Inc. Roy Franco, Franco Signor, LLC Brad Spicer,

More information

Medicare Secondary Payer Commercial Repayment Center. Group Health Plan (GHP) Recovery Process

Medicare Secondary Payer Commercial Repayment Center. Group Health Plan (GHP) Recovery Process Medicare Secondary Payer Commercial Repayment Center Group Health Plan (GHP) Recovery Process Topics Introduction of the Commercial Repayment Center CGI Federal Responsibilities Transition Plan Customer

More information

Prepared by Whitney L. Teel, Esq.

Prepared by Whitney L. Teel, Esq. New Medicare Notice And Reporting Regulations: A Discussion On How To Settle Cases Without Exposing Clients To Penalties Under The Medicare Secondary Payer Act Prepared by Whitney L. Teel, Esq. I. Introduction

More information

INSTRUCTION LETTER TRONOX TORT CLAIMS TRUST INSTRUCTION LETTER (CATEGORY A) Dear Prospective Claimant or Claimant Counsel,

INSTRUCTION LETTER TRONOX TORT CLAIMS TRUST INSTRUCTION LETTER (CATEGORY A) Dear Prospective Claimant or Claimant Counsel, INSTRUCTION LETTER Dear Prospective Claimant or Claimant Counsel, The Tronox Incorporated Tort Claims Trust (the Trust ) has been established under Chapter 11 of the Bankruptcy Code to resolve all Tort

More information

Glossary of Terms and Acronyms

Glossary of Terms and Acronyms Glossary of Terms and Acronyms COB/COBC Coordination of Benefits - The Coordination of Benefits Contractor consolidates the activities that support the collection, management, and reporting of other insurance

More information

Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment

Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Effective Date: September 1, 2013 Effective Date for Section 32 Agreements: October 1, 2013 Revised: December

More information

Liability Set Asides Why There is a Need for Codification

Liability Set Asides Why There is a Need for Codification Liability Set Asides Why There is a Need for Codification Jason D. Lazarus, Esq. For many years personal injury cases have been resolved without consideration of Medicare s secondary payer status even

More information

Set-Aside Arrangements A Combined Effort by Robert W. Brown II, Esq. Moore Ingram Johnson & Steele, LLP

Set-Aside Arrangements A Combined Effort by Robert W. Brown II, Esq. Moore Ingram Johnson & Steele, LLP Set-Aside Arrangements A Combined Effort by Overview: When is Medicare an issue? What is required when Medicare is an issue? Dealing with CMS and Medicare. Problems associated with Medicare in the context

More information

Medicare Secondary Payer (MSP) Manual Chapter 5 - Contractor Prepayment Processing Requirements

Medicare Secondary Payer (MSP) Manual Chapter 5 - Contractor Prepayment Processing Requirements Medicare Secondary Payer (MSP) Manual Chapter 5 - Contractor Prepayment Processing Requirements Transmittals for Chapter 5 Table of Contents (Rev. 113, 08-06-15) 10 - Coordination With the Coordination

More information

8/17/2012. Workers Compensation Institute. Learning Objectives. Agenda. 2012 Educational Conference

8/17/2012. Workers Compensation Institute. Learning Objectives. Agenda. 2012 Educational Conference Workers Compensation Institute 2012 Educational Conference Seeing the Forest through the Trees: MSA/LMSA Trends Celia Mendez, Esq. Cynthia Sage, Esq. Rafael Gonzalez Moreland & Mendez FCCI Insurance Gould

More information

DEFINITIONS: POLICY: Office for the Protection of Research Subjects Institutional Review Board. Page 1 of 5 OVCR Document #0933

DEFINITIONS: POLICY: Office for the Protection of Research Subjects Institutional Review Board. Page 1 of 5 OVCR Document #0933 Office for the Protection of Research Subjects Institutional Review Board Sponsor Payment for Costs Related to Subject Injury in Industry- Sponsored Clinical Trials Guidance Version: 1.2 Date: 3/27/2015

More information

Medicare, Workers Compensation, and Liability Insurance

Medicare, Workers Compensation, and Liability Insurance CAS Study Note Medicare, Workers Compensation, and Liability Insurance By George M. Levine, FCAS, MAAA Patty Smolen, FCAS, MAAA Jim Klann, FCAS, MAAA October 2012 Medicare, Workers Compensation, and Liability

More information

Medicare in Personal Injury Claim Settlements: Complying with Reporting Requirements and Satisfying Liens

Medicare in Personal Injury Claim Settlements: Complying with Reporting Requirements and Satisfying Liens Presenting a 90-Minute Encore Presentation of the Teleconference with Live, Interactive Q&A Medicare in Personal Injury Claim Settlements: Complying with Reporting Requirements and Satisfying Liens TUESDAY,

More information

Medicare Update: Information to Help with the Darkness of Medicare Compliance. Peter H. Wayne IV, Esq.

Medicare Update: Information to Help with the Darkness of Medicare Compliance. Peter H. Wayne IV, Esq. FOR PUBLICATION IN THE 2012 WINTER EDITION OF THE ARKANSAS TRIAL LAWYERS ASSOCIATION S DOCKET Medicare Update: Information to Help with the Darkness of Medicare Compliance Peter H. Wayne IV, Esq. No matter

More information

Medicare Secondary Payer In Action Recent Developments and Practical Tips. Eli Poliakoff, Esq. Gregory M. Fliszar, Esq.

Medicare Secondary Payer In Action Recent Developments and Practical Tips. Eli Poliakoff, Esq. Gregory M. Fliszar, Esq. Medicare Secondary Payer In Action Recent Developments and Practical Tips Eli Poliakoff, Esq. Gregory M. Fliszar, Esq. I. Relevant Authorities and Resources The MSP program is a wide-ranging collection

More information

Hospital Liens, Medicare and Medicaid: Trouble Ahead?

Hospital Liens, Medicare and Medicaid: Trouble Ahead? A MEDICAL-LEGAL NEWSLETTER FOR PERSONAL INJURY ATTORNEYS BY DR. STEVEN W.SHAW Hospital Liens, Medicare and Medicaid: Trouble Ahead? Several years ago I was informed by an attorney that Danbury Hospital

More information

Understanding Workers Compensation Claims

Understanding Workers Compensation Claims Understanding Workers Compensation Claims DESIREE TOLBERT, SEDGWICK CLAIMS MANAGEMENT SERVICES ROB VAN EPPS, FCAS, MAAA, FINANCIAL RISK ANALYSTS RAFAEL GONZALEZ, GOULD & LAMB, LLC Understanding Worker's

More information

GUILFORD COUNTY REQUEST FOR PROPOSALS EVENT 515 THIRD PARTY ADMINISTRATOR SERVICES LIABILITY CLAIMS. And WORKERS COMPENSATION CLAIMS

GUILFORD COUNTY REQUEST FOR PROPOSALS EVENT 515 THIRD PARTY ADMINISTRATOR SERVICES LIABILITY CLAIMS. And WORKERS COMPENSATION CLAIMS GUILFORD COUNTY REQUEST FOR PROPOSALS EVENT 515 THIRD PARTY ADMINISTRATOR SERVICES LIABILITY CLAIMS And WORKERS COMPENSATION CLAIMS Page 1 of 14 THIRD PARTY ADMINISTRATOR SERVICES LIABILITY CLAIMS AND

More information

Policy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements

Policy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements Policy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements Effective Date: October 1, 2013 Revised: January 4, 2015 I. Authority A. The James Zadroga 9/11 Health and Compensation Act

More information

Maryland Workers Compensation Commission Introduction

Maryland Workers Compensation Commission Introduction Maryland Workers Compensation Commission Introduction Medicare Secondary Payer Act & Workers Compensation Settlement Process What this is not... This presentation is not a tutorial on how to create and

More information

MEDICAL PROFESSIONAL LIABILITY INSURANCE MANDATORY REPORTING OF DETAILED CLAIM INFORMATION

MEDICAL PROFESSIONAL LIABILITY INSURANCE MANDATORY REPORTING OF DETAILED CLAIM INFORMATION MEDICAL PROFESSIONAL LIABILITY INSURANCE MANDATORY REPORTING OF DETAILED CLAIM INFORMATION GENERAL INSTRUCTIONS AND INFORMATION FREQUENTLY ASKED QUESTIONS Most Recent Update: January 6, 2014 Background:

More information

Liability Claims in the Medicare Secondary Payer Arena: Planning the Medicare Set-Aside

Liability Claims in the Medicare Secondary Payer Arena: Planning the Medicare Set-Aside Liability Claims in the Medicare Secondary Payer Arena: Planning the Medicare Set-Aside Charles D. Joyner Christine E. Harper I. Introduction Debate continues as to how to handle liability claims when

More information

Self-Administration Toolkit for Workers Compensation Medicare Set-Aside Arrangements (WCMSAs)

Self-Administration Toolkit for Workers Compensation Medicare Set-Aside Arrangements (WCMSAs) Self-Administration Toolkit for Workers Compensation Medicare Set-Aside Arrangements (WCMSAs) For WCMSAs Approved by the Centers for Medicare & Medicaid Services (CMS) Version 1.1 January 5, 2015 1 Table

More information

Reforming Medicare Secondary Payer Compliance The SMART Act.. Is There Hope on the Horizon?

Reforming Medicare Secondary Payer Compliance The SMART Act.. Is There Hope on the Horizon? Reforming Medicare Secondary Payer Compliance The SMART Act.. Is There Hope on the Horizon? By: Mark Popolizio, Esquire* Over the past several years, Medicare has become more aggressive in asserting its

More information

MEDICARE AND WORKERS= COMPENSATION CLAIMS WHO=S ON FIRST? Michael E. Rusin. January, 2002

MEDICARE AND WORKERS= COMPENSATION CLAIMS WHO=S ON FIRST? Michael E. Rusin. January, 2002 MEDICARE AND WORKERS= COMPENSATION CLAIMS WHO=S ON FIRST? Michael E. Rusin January, 2002 Michael E. Rusin Rusin Maciorowski & Friedman, Ltd. 10 South Riverside Plaza, Suite 1530 Chicago, IL 60606 (312)

More information

USING MEDICARE SET-ASIDE ARRANGEMENTS IN THIRD PARTY LIABILITY CASES By: Thomas D. Begley, Jr.

USING MEDICARE SET-ASIDE ARRANGEMENTS IN THIRD PARTY LIABILITY CASES By: Thomas D. Begley, Jr. USING MEDICARE SET-ASIDE ARRANGEMENTS IN THIRD PARTY LIABILITY CASES By: Thomas D. Begley, Jr. This Special Report is brought to you by Begley Law Group. begleylawgroup.com This newsletter is not intended

More information

ALERT: October 2011 TIN Reference Response File and Address Validation Information for Group Health Plan (GHP) Responsible Reporting Entities (RREs)

ALERT: October 2011 TIN Reference Response File and Address Validation Information for Group Health Plan (GHP) Responsible Reporting Entities (RREs) Offe of Financial Management/Financial Serves Group April 1, 2011 (Revised May 17, 2011) Implementation of Medare Secondary Payer Mandatory Reporting Provisions in Section 111 of the Medare, Medaid, and

More information

MEDICARE SET-ASIDE UPDATE

MEDICARE SET-ASIDE UPDATE MEDICARE SET-ASIDE UPDATE I. Social Security Disability Benefits A. Social Security Disability Income (SSDI) B. Obtained via application to the Social Security Administration C. Informal Hearing process

More information

Introduction...2. Definitions...2. Order of Benefit Determination...3

Introduction...2. Definitions...2. Order of Benefit Determination...3 Introduction...2 Definitions...2 Order of Benefit Determination...3 COB with Medicare...4 When the HMO Is Primary and Medicare Is Secondary... 4 When Medicare Is Primary Payer and the HMO Is Secondary...

More information

Michigan Property & Casualty Guaranty Association P.O. Box 531266 Livonia, Michigan 48153-1266 Phone: (248) 482-0381

Michigan Property & Casualty Guaranty Association P.O. Box 531266 Livonia, Michigan 48153-1266 Phone: (248) 482-0381 Michigan Property & Casualty Guaranty Association P.O. Box 531266 Livonia, Michigan 48153-1266 Phone: (248) 482-0381 Dear Claimant: The Michigan Property & Casualty Guaranty Association ("the MPCGA") is

More information

Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment

Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Effective Date: September 1, 2013 I. Authority A. The James Zadroga 9/11 Health and Compensation Act of 2010

More information

Meeting the Obligation to Consider Medicare s Interests in Thirdparty Liability Cases; Medicare Set-Asides and Beyond Panic: No/Prepare: Yes

Meeting the Obligation to Consider Medicare s Interests in Thirdparty Liability Cases; Medicare Set-Asides and Beyond Panic: No/Prepare: Yes Richard L. Gilbert Richard L. Gilbert Judge of the Superior Court, Retired Amanda C. Gilbert Judge, Retired Resolution Arts Building Attorney at Law 2630 J Street Sacramento, Calif. 95816 Tel (916) 442-0414/Fax

More information

NEGOTIATING WITH MEDICARE AND MEDICAID

NEGOTIATING WITH MEDICARE AND MEDICAID NEGOTIATING WITH MEDICARE AND MEDICAID I. MEDICARE PROVIDES HEALTHCARE COVERAGE A. Persons 65 Years Old and Older B. Certain Disabled Persons under 65 C. Persons with End-Stage Renal Disease II. MEDICARE

More information

Special Challenges for the Toxic Torts Practitioner Steven J. Joffe and Maria A. Caruana

Special Challenges for the Toxic Torts Practitioner Steven J. Joffe and Maria A. Caruana T o x i c T o r t s a n d E n v i r o n m e n ta l L a w Taming the MMSEA Beast By Mary Ellen Gambino, Special Challenges for the Toxic Torts Practitioner Steven J. Joffe and Maria A. Caruana The frustration

More information

MSPRC Conditional Payment Investigation and Reconciliation Request

MSPRC Conditional Payment Investigation and Reconciliation Request MSPRC Conditional Payment Investigation and Reconciliation Request You have requested my office be engaged to investigate and/or reconcile Medicare conditional payment information. Below you will find

More information

No Medicare Payments for a Claimant's Work-Related Injury or Disease until the WCMSA has been Exhausted

No Medicare Payments for a Claimant's Work-Related Injury or Disease until the WCMSA has been Exhausted No Medicare Payments for a Claimant's Work-Related Injury or Disease until the WCMSA has been Exhausted (Ref: 7/23/01 Memo) The purpose of a Workers' Compensation Medicare Set-aside Arrangement (WCMSA)

More information

Subpart B Insurance Coverage That Limits Medicare Payment: General Provisions

Subpart B Insurance Coverage That Limits Medicare Payment: General Provisions Subpart B Insurance Coverage That Limits Medicare Payment: General Provisions 411.20 Basis and scope. (a) Statutory basis. (1) Section 1862(b)(2)(A)(i) of the Act precludes Medicare payment for services

More information

Instructions For Filing a Malignant Claim With Pittsburgh Metals Asbestos Settlement Trust

Instructions For Filing a Malignant Claim With Pittsburgh Metals Asbestos Settlement Trust Instructions For Filing a Malignant Claim With The MALIGNANT CLAIM FORM & DECLARATION (the Claim Form ), is required of all Injured Parties filing a claim with the Pittsburgh Metals Asbestos Settlement

More information

Automobile Insurance & the Use of ICD 10 Codes. April 17, 2012 Baltimore, MD

Automobile Insurance & the Use of ICD 10 Codes. April 17, 2012 Baltimore, MD Automobile Insurance & the Use of ICD 10 Codes April 17, 2012 Baltimore, MD American Insurance Association, Washington, DC The American Insurance Association (AIA) is the leading property-casualty(p/c)

More information

MEDICARE AND MEDICAID AVOIDING POST-JUDGMENT AND POST-SETTLEMENT LITIGATION WORKERS COMPENSATION AND MEDICARE SET ASIDE ISSUES

MEDICARE AND MEDICAID AVOIDING POST-JUDGMENT AND POST-SETTLEMENT LITIGATION WORKERS COMPENSATION AND MEDICARE SET ASIDE ISSUES MEDICARE AND MEDICAID AVOIDING POST-JUDGMENT AND POST-SETTLEMENT LITIGATION WORKERS COMPENSATION AND MEDICARE SET ASIDE ISSUES INTRODUCTION Over the last 10 years workers compensation practitioners have

More information